Spangler J G, Salisbury P L
Department of Family and Community Medicine, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, NC 27157-1084, USA.
Am Fam Physician. 1995 Oct;52(5):1421-30, 1433-4.
Smokeless tobacco is an extremely addictive substance with a high rate of use in certain demographic groups, such as adolescents and Native Americans. In the past 20 years, the use of smokeless tobacco has almost tripled. Health risks include leukoplakia (a premalignant oral lesion), oral cancer and systemic nicotine effects such as elevated blood pressure and serum cholesterol levels. To avoid or control these effects, family physicians should identify patients who use smokeless tobacco and encourage and support cessation efforts. Patients who are unsure about quitting need the risks of their habit personalized, and those who are actively trying to stop using smokeless tobacco need emotional and, in some cases, therapeutic support (e.g., nicotine replacement therapy). The family physician should encourage patients who appear motivated to stop using smokeless tobacco to set a quit date in the very near future. However, all smokeless tobacco users--regardless of their motivation to quit--need to be followed to ensure compliance with cessation advice or to detect medical complications from use of this form of tobacco.
无烟烟草是一种极易上瘾的物质，在某些特定人群中，如青少年和美国原住民，使用率很高。在过去20年里，无烟烟草的使用量几乎增长了两倍。健康风险包括白斑（一种癌前口腔病变）、口腔癌以及全身性尼古丁影响，如血压升高和血清胆固醇水平升高。为避免或控制这些影响，家庭医生应识别使用无烟烟草的患者，并鼓励和支持他们戒烟。不确定是否戒烟的患者需要了解其习惯带来的个性化风险，而那些积极尝试停止使用无烟烟草的患者则需要情感支持，在某些情况下还需要治疗支持（如尼古丁替代疗法）。家庭医生应鼓励那些似乎有动力停止使用无烟烟草的患者在不久的将来设定一个戒烟日期。然而，所有无烟烟草使用者——无论其戒烟动机如何——都需要接受随访，以确保他们遵守戒烟建议，或检测使用这种烟草形式引发的医疗并发症。
